Abstract

ACTH (Adrenocorticotropic hormone) - dependent bilateral adrenocortical hyperplasia, known as Cushing's disease, accounts for 60-70% of the cases of Cushing's syndrome. In about 30 - 40% of patients, manifestations of Cushing's syndrome occur independently of pituitary ACTH due to either ectopic ACTH production or an adrenecortiacal nodüler dysplasia, in which adjacent areas of the adrenal cortex are atrophic. Treatment of Cushing's syndrome is based on the etiopathogenesis. There are three approaches: Surgery of pituitary or adrenal gland, irradiation of pituitary and medical treatment. Cushing's disease is best treated by transsphenoidal removal of the pituitary adenoma. Adrenalectomy, once the most accepted approach, plays a secondaıy role and is indicated primarily in adrenocortical nodular dysplasia and adrenal adenoma.